Ukulungiswa kwezikrufu zangaphambili kwenkqubo ye-odontoid kugcina umsebenzi wokujikeleza we-C1-2 kwaye kuye kwaxelwa kwiincwadi ukuba kunezinga lokudibana kwe-88% ukuya kwi-100%.
Ngowama-2014, uMarkus R nabanye bapapashe isifundo malunga nendlela yotyando yokulungisa izikrufu zangaphambili kwiimfanta ezingasebenzi kakuhle kwiThe Journal of Bone & Joint Surgery (Am). Eli nqaku lichaza ngokweenkcukacha iingongoma eziphambili zendlela yotyando, ulandelelwano emva kotyando, izalathiso kunye namanyathelo okhuseleko ngamanyathelo amathandathu.
Eli nqaku ligxininisa ukuba kuphela ukwaphuka kohlobo lwesibini okuvumelekileyo ukulawula ukufakelwa kwesikrufu ngaphambili kwaye ukufakelwa kwesikrufu esinye esingenanto kuyathandwa.
Inyathelo 1: Indawo yesigulana esibekwe kuyo ngexesha lotyando
1. Kufuneka kuthathwe ii-radiographs ezifanelekileyo ze-anteroposterior kunye ne-lateral ukuze zisetyenziswe ngumqhubi.
2. Isigulana kufuneka sigcinwe sivule umlomo ngexesha lotyando.
3. Iqhekeza eliqhekekileyo kufuneka libekwe endaweni yalo kangangoko kunokwenzeka ngaphambi kokuba kuqalwe utyando.
4. Umqolo wesibeleko kufuneka wolulwe kakhulu kangangoko ukuze ufumane ukuvezwa okufanelekileyo kwesiseko senkqubo ye-odontoid.
5. Ukuba i-hyperextension yomqolo wesibeleko ayinakwenzeka – umz., kwi-hyperextension fractures kunye nokufuduka kwangasemva kwesiphelo se-cephalad senkqubo ye-odontoid – ngoko ke kunokwenziwa ingqwalasela ekuguquleni intloko yesigulana kwicala elahlukileyo xa kuthelekiswa nomzimba waso.
6. vala intloko yesigulana ingasebenzi kakuhle kangangoko kunokwenzeka. Ababhali basebenzisa ifreyimu yentloko kaMayfield (eboniswe kwiMifanekiso 1 no-2).
Inyathelo lesi-2: Indlela yotyando
Indlela eqhelekileyo yotyando isetyenziswa ukuze kubonakale umaleko wangaphambili we-tracheal ngaphandle kokonakalisa naziphi na izakhiwo ezibalulekileyo zomzimba.
Inyathelo lesi-3: Indawo yokungena ngesikrufu
Indawo efanelekileyo yokungena ifumaneka kumda ongaphantsi ongaphambili wesiseko somzimba we-C2 vertebral. Ke ngoko, umphetho ongaphambili wediski ye-C2-C3 kufuneka uvezwe. (njengoko kubonisiwe kwiMifanekiso 3 kunye ne-4 ngezantsi) Umfanekiso 3
Utolo olumnyama olukuMfanekiso 4 lubonisa ukuba umqolo we-C2 ongaphambili ujongwa ngononophelo ngexesha lokufundwa kwefilimu ye-axial CT ngaphambi kotyando kwaye kufuneka usetyenziswe njengophawu lokwakheka komzimba ukuze kuchongwe indawo yokufaka inaliti ngexesha lotyando.
2. Qinisekisa indawo yokungena phantsi kwembonakalo ye-anteroposterior kunye ne-lateral fluoroscopic yomqolo wesibeleko. 3.
3. Slayida inaliti phakathi komphetho ongaphambili ophezulu wepleyiti ephezulu ye-C3 kunye nendawo yokungena ye-C2 ukuze ufumane indawo yokungena yesikrufu efanelekileyo.
Inyathelo lesi-4: Ukubeka isikrufu
1. Inaliti ye-GROB enobubanzi obuyi-1.8 mm ifakwa kuqala njengesikhokelo, inaliti ijongeke kancinci emva kwencam ye-notochord. Emva koko, kufakwa isikrufu esingenanto esinobubanzi obuyi-3.5 mm okanye 4 mm. Inaliti kufuneka ihlale ibekwe kwi-cephalad ephucukileyo kancinci phantsi kokujonga i-anteroposterior kunye ne-lateral fluoroscopic.
2. Beka i-hollow drill kwicala le-guide pin phantsi kwe-fluoroscopic monitoring kwaye uyiqhubele phambili kancinci ide ingene kwindawo eqhekekileyo. I-hollow drill akufuneki ingene kwi-cortex yecala le-cephalad le-notochord ukuze i-guide pin ingaphumi kunye ne-hollow drill.
3. Linganisa ubude besikrufu esingenanto esifunekayo kwaye usiqinisekise ngokulinganisa i-CT ngaphambi kotyando ukuze kuthintelwe iimpazamo. Qaphela ukuba isikrufu esingenanto kufuneka singene kwithambo le-cortical kwincam yenkqubo ye-odontoid (ukuze kube lula inyathelo elilandelayo lokucinezelwa kwesiphelo se-fracture).
Kwiimeko ezininzi zababhali, isikrufu esinye esingenanto sisetyenzisiwe ukuqinisa, njengoko kubonisiwe kuMfanekiso 5, okwindawo ephakathi kwisiseko senkqubo ye-odontoid ejongene ne-cephalad, apho incam yesikrufu ingena nje kwithambo le-cortical elingasemva kwincam yenkqubo ye-odontoid. Kutheni kucetyiswa isikrufu esinye? Ababhali bagqibe kwelokuba kuya kuba nzima ukufumana indawo efanelekileyo yokungena kwisiseko senkqubo ye-odontoid ukuba izikrufu ezimbini ezahlukeneyo ziza kubekwa kwi-5 mm ukusuka kumgca ophakathi we-C2.
Umfanekiso 5 ubonisa isikrufu esingenanto esisembindini wenkqubo ye-odontoid ejongene ne-cephalad, apho incam yesikrufu ingena nje kwi-cortex yethambo ngasemva nje kwencam yenkqubo ye-odontoid.
Kodwa ngaphandle kwento yokhuseleko, ngaba izikrufu ezibini ziyakwandisa uzinzo emva kotyando?
Uphononongo lwe-biomechanical olwapapashwa ngo-2012 kwijenali i-Clinical Orthopaedics and Related Research ebhalwe nguGang Feng et al. weRoyal College of Surgeons of the United Kingdom lubonise ukuba isikrufu esinye kunye nezikrufu ezimbini zibonelela ngenqanaba elifanayo lokuzinza ekulungiseni ukwaphuka kwe-odontoid. Ke ngoko, isikrufu esinye sanele.
4. Xa indawo yokuqhekeka kunye neepini zesikhokelo ziqinisekisiwe, kubekwa izikrufu ezifanelekileyo ezingenanto. Indawo yezikrufu kunye neepini kufuneka ijongwe phantsi kwe-fluoroscopy.
5. Kufuneka kuthathwe ingqwalasela ukuqinisekisa ukuba isixhobo sokukrufula asibandakanyi izicubu ezithambileyo ezijikelezileyo xa kusenziwa nayiphi na imisebenzi engentla. 6. Qinisa izikrufu ukuze ufake uxinzelelo kwindawo eqhekekileyo.
Inyathelo lesi-5: Ukuvalwa kwenxeba
1. Hlamba indawo yotyando emva kokugqiba ukubeka isikrufu.
2. Ukucoca ngokupheleleyo i-hemostasis kubalulekile ukunciphisa iingxaki emva kotyando ezifana nokucinezelwa kwe-hematoma ye-trachea.
3. Umsipha we-cervical latissimus dorsi osikiweyo kufuneka uvalwe ngendlela echanekileyo kungenjalo ubuhle besilonda sasemva kotyando buya konakala.
4. Akunyanzelekanga ukuba kuvalwe ngokupheleleyo iileya ezinzulu.
5. Ukukhupha amanzi emanxebeni akuyomfuneko (ababhali abadli ngokubeka amanzi emva kotyando).
6. Kucetyiswa ukuba kufakwe imithungo ngaphakathi kwesikhumba ukuze kuncitshiswe impembelelo kwinkangeleko yesigulana.
Inyathelo 6: Ukulandelela
1. Izigulana maziqhubeke zinxibe i-braces eqinileyo entanyeni kangangeeveki ezi-6 emva kotyando, ngaphandle kokuba unyango lokunyanga lufuna oko, kwaye mazihlolwe ngemifanekiso yasemva kotyando rhoqo.
2. Ii-radiographs eziqhelekileyo ze-anteroposterior kunye ne-lateral zomqolo wesibeleko kufuneka zihlolwe kwiiveki ezi-2, ezi-6, nezi-12 kunye neenyanga ezi-6 nezi-12 emva kotyando. I-CT scan yenziwe kwiiveki ezili-12 emva kotyando.
Ixesha lokuthumela: Disemba-07-2023
